Living With Diabetes

Supplements to Make the Job Easier (Part I)

References

There are two primary types of diabetes: Type I and Type II. Both types result in high blood sugar levels, which may manifest as any of the following symptoms: increased thirst and need to urinate; feeling edgy, tired and nauseous; and increased appetite with weight loss. Other symptoms may include repeated or hard-to-heal infections of the skin, gums, vagina or bladder; blurred vision; tingling or loss of feeling in the hands or feet; and dry, itchy skin. If left uncontrolled, high blood sugar may result in a variety of serious complications.

Many of these complications are the result of glycosylated protein (GP). GP simply means the sugar (glucose) has attached itself to protein. Virtually all proteins are glycosylated to some degree. However, if this process continues to excess, it creates compounds called Advanced Glycosylation End Products (AGE), which can become permanent fixtures in the cells. AGE-impregnated cells are very reactive with one another and with other proteins. In the case of capillaries, they can result in capillary wall thickening, eventually causing the vessels to be blocked off. This is the underlying cause of kidney complications (nephropathy) and eye complications (retinopathy).

Another mechanism by which complications in diabetes result is excessive cellular sorbitol (a type of sugar-alcohol). Many cells in the body do not rely on insulin for glucose uptake. In the case of hyperglycemia, there are high sugar levels inside these cells, which causes sorbitol to be produced in high concentrations. Intracellular sorbitol disrupts the pressure balance between the inside and outside of the cell, causing water to enter. This swelling of nerve cells is what is believed to be, at least in part, responsible for the nerve damage (neuropathy) caused by diabetes.

As mentioned earlier, there are two types of diabetes, and it is important to understand their differences in pathology and treatment. Type I, immune-mediated diabetes—formerly called insulin-dependent diabetes—is a disease that affects the way the body uses food. In Type I diabetes, the body destroys the cells in the pancreas that produce insulin, usually leading to a total failure to produce insulin. It typically starts in children or young adults who are slim, but can start at any age. Without insulin, the body cannot control blood sugar levels and will eventually die. So people with Type I diabetes give themselves at least one shot of insulin every day. An estimated 500,000 to 1 million Americans have this type of diabetes. Conventional medical treatment for Type I diabetes includes insulin injections and diet regulation.

Type II diabetes used to be called non-insulin-dependent diabetes. The most common type of diabetes, it affects about 15 million Americans—nine out of 10 cases of diabetes are Type II. It usually occurs in people over 45 and overweight, among other factors. In Type II diabetes, the body does not make enough insulin or it can’t properly use it. Without enough insulin, the body cannot effectively move blood sugar into the cells. As sugar builds up in the bloodstream, the body releases increasing amounts of insulin, overwhelming the organs. Conventional medical treatment for Type II diabetes includes any of the following, alone or in combination: insulin injections, oral drugs or diet.

There are a number of dietary ingredients that may help diabetics gain greater control over their blood sugar levels and/or reduce the long-term detrimental effects of high blood sugar levels. However, if you are speaking with customers who are diabetic with the condition controlled by medication, it is critical that they make their health care providers aware of any changes they might make in their lifestyle. Diet, exercise and supplements may affect blood sugar levels. By making the health care provider a participant in any lifestyle changes, these customers will ensure their health is properly monitored.

In part one of this article, we’ll examine some of the botanical compounds that may prove beneficial to diabetics managing their blood sugar. Look for more on specific minerals and antioxidants that are important in diabetes in the December issue of HSR: Health Supplement Retailer.

Banaba is the common name for Lagerstroemia speciosa, a traditional herbal medicine used among diabetics in the Philippines.¹ Research done on banaba extract has demonstrated it has an “insulin-like principle” as well as an ability to reduce blood sugar. At least one component of this insulin-like principle is thought to be corosolic acid, although banaba also contains other like candidates including ellagitannins, lagerstroemin, flosin B and reginin A. As a matter of fact, a recent study identified ellagitannins from banaba as activators of glucose transport.²

One of the banaba studies was conducted on hereditary diabetic mice.³ The results showed blood sugar increases were suppressed, and the level of serum insulin and the amount of urinary excreted glucose were also lowered in mice fed banaba extract. The researchers suggested banaba extract has beneficial effects on control of blood levels of glucose in non-insulin dependent diabetes mellitus.

Human studies have also been promising. Twelve diabetic subjects taking 48 mg of banaba extract (as GlucoTrim®, from OptiPure/Soft Gel Technologies) were tested in a randomized, double blind, crossover study.⁴ This study confirmed banaba extract promotes normal blood glucose metabolism in people with Type II diabetes, and also showed banaba extract’s benefits were sustained for several weeks even after discontinuation of the supplement. Another crossover, placebo-controlled clinical study with 24 subjects found similar results.⁵ Specifically, banaba extract was effective in reducing blood glucose levels even in short-term (four weeks) treatment, with no signs of adverse effects. Furthermore, even a one-time dose left a memory-effect for blood glucose control. Compared to the placebo group, a statistically significant drop in the average blood glucose level was observed with the administration of banaba extract.

Animal studies have demonstrated the herb Gymnema sylvestre is capable of lowering blood glucose levels, improving glucose utilization and increasing insulin levels in diabetes.^6,7,8,9 The latter benefit was found to be a function of gymnema’s apparent ability to repair/regenerate beta cells, the parts of the pancreas responsible for producing insulin.¹⁰

Of greater significance to diabetic patients is the research conducted on humans. In one study, 22 Type II diabetic patients received gymnema for 18 to 20 months as a supplement to conventional oral drugs.¹¹ During gymnema supplementation, the patients showed a significant reduction in blood glucose, glycosylated hemoglobin and glycosylated blood proteins; and conventional drug dosage could be decreased. As a matter of fact, five of the 22 diabetic patients were able to discontinue their conventional drugs and maintain their blood glucose homeostasis with gymnema alone. The researchers concluded, “These data suggest that the beta cells may be regenerated/repaired in Type II diabetic patients on [gymnema] supplementation. This is supported by the appearance of raised insulin levels in the serum of patients after [gymnema] supplementation.”

In a similar study, gymnema was administered to 27 patients with Type I diabetes, who were also on insulin therapy.¹² The results were that insulin requirements came down together with blood glucose and glycosylated hemoglobin and glycosylated blood protein levels. Blood fats also returned to near normal levels with gymnema therapy. Type I diabetic patients who were just on insulin therapy showed no significant reduction in serum lipids, glycosylated hemoglobin or glycosylated blood protein when followed up after 10 to 12 months. The researchers of this study concluded, “Gymnema therapy appears to enhance endogenous insulin, possibly by regeneration/revitalization of the residual beta cells in insulin-dependent diabetes mellitus.”

Bitter melon (Momordica charantia) is a tropical vegetable widely cultivated in Asia, Africa and South America, and has been used extensively in traditional folk medicine as a remedy for diabetes. This traditional use has also been validated by clinical research. In one study, bitter melon significantly improved the glucose tolerance of three-quarters of patients with Type II diabetes.¹³ During another study, bitter melon significantly reduced blood glucose concentrations during a glucose tolerance test in Type II diabetics.¹⁴ Other research has identified the protein component of bitter melon that has the blood sugar lowering effects, and those researchers have stated it is very effective for that purpose when administered to “gerbils, langurs and humans.”¹⁵

Fenugreek (Trigonella foenum-graecum) has been used as a traditional herbal medicine for treating diabetes. Modern scientific research lends support to this traditional use. As the result of research conducted on diabetic rats and humans, the International Journal of Obesity recognized fenugreek as having potential benefit for the control of glucose metabolism.¹⁸ Other research in animals^{19,20,21,22,23} as well as humans ^24,25 has shown fenugreek is capable of lowering blood glucose levels in diabetic and non-diabetic subjects.

Some of the studies assumed it was the soluble fiber content of the fenugreek seeds that provided the glucose modulating effect. However, other studies found that there were other natural components present that are also involved.^26,27 In fact, one study pinpointed an enzyme in fenugreek that is implicated in synthesizing an unusual amino acid called 4-hydroxyisoleucine, which is known for its insulin stimulating effect.²⁸

November 2005 Health Supplement Retailer
"Living With Diabetes: Supplements To Make the Job Easier (Part I)" References

1. Suzuki Y et al. "Antiobesity activity of extracts from Lagerstroemia speciosa L. leaves on female KK-Ay mice." J Nutr Sci Vitaminol (Tokyo). 45, 6:791-5, 1999. http://eishoku.bcasj.or.jp/journal-e.html

2. Hayashi T et al. "Ellagitannins from Lagerstroemia speciosa as activators of glucose transport in fat cells." Planta Med. 68, 2:173-5, 2002.

3. Kakuda T et al. "Hypoglycemic effect of extracts from Lagerstroemia speciosa L. leaves in genetically diabetic KK-AY mice." Biosci Biotechnol Biochem. 60, 2:204-8, 1996. www.jsbba.or.jp/bbindexj.html

4. Judy WV. "Glucosol™ Clinical Study Synopsis." Report from Soft Gel Technologies Inc. 1999.

5. ibid.

6. Shimizu K et al. "Suppression of glucose absorption by extracts from the leaves of Gymnema inodorum." J Vet Med Sci. 59, 9:753-7, 1997. http://jvms.jstage.jst.go.jp/en/

7. Okabayashi Y et al. "Effect of Gymnema sylvestre, R.Br. on glucose homeostasis in rats." Diabetes Res Clin Pract. 9, 2:143-8, 1990. www.sciencedirect.com/science/journal/01688227

8. Shanmugasundaram KR et al. "Enzyme changes and glucose utilization in diabetic rabbits: the effect of Gymnema sylvestre, R.Br." J Ethnopharmacol. 7, 2:205-34, 1983. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

9. Shanmugasundaram ER et al. "Possible regeneration of the islets of Langerhans in streptozotocin-diabetic rats given Gymnema sylvestre leaf extracts." J Ethnopharmacol. 30, 3:265-79, 1990. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

10. ibid.

11. Baskaran K et al. "Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients." J Ethnopharmacol. 30, 3:295-300, 1990. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

12. Shanmugasundaram ER et al. "Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus." J Ethnopharmacol. 30, 3:281-94, 1990. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

13. Welihinda J et al. "Effect of Momordica charantia on the glucose tolerance in maturity onset diabetes." J Ethnopharmacol. 17, 3:277-82, 1986. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

14. Leatherdale BA et al. "Improvement in glucose tolerance due to Momordica charantia (karela)." Br Med J (Clin Res Ed). 282, 6279:1823-4, 1981.

15. Khanna P et al. "Hypoglycemic activity of polypeptide-p from a plant source." J Nat Prod. 44, 6:648-55, 1981.

16. Vuksan V et al. "American ginseng (Panax quinquefolius L.) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus." Arch Intern Med. 160:1009–13, 2000. http://archinte.ama-assn.org

17. Vuksan V et al. "American ginseng (Panax quinquefolius L.) attenuates postprandial glycemia in a time-dependent but not dose-dependent manner in healthy individuals." Am J Clin Nutr. 73, 4:753-8, 2001. www.ajcn.org

18. Madar Z. "New source of dietary fiber." Int J Obes. Suppl.1:57-65, 1987. www.nature.com/ijo

19. Ajabnoor MA, Tilmisany AK. "Effect of Trigonella foenum graecum on blood glucose levels in normal and alloxandiabetic mice." J Ethnopharmacol. 22, 1:45-49, 1988. www.elsevier.nl/inca/publications/store/5/0/6/0/3/5

20. Al-Habori M, Raman A. "Antidiabetic and hypocholesterolemic effects of fenugreek."  Phytother Res. 12:233-242, 1988. www.interscience.wiley.com/jpages/0951-418X

21. Khosla P, Gupta DD, Nagpal RK. "Effect of Trigonella foenum graecum (Fenugreek) on blood glucose in normal and diabetic rats." Ind J Physiol Pharmacol. 39:173-174, 1995.

22. Ali L et al. "Characterization of the hypoglycemic effects of Trigonella foenum graecum seed." Planta Med. 61:358-360, 1995.

23. Ribes G et al. "Antidiabetic effects of subfractions from fenugreek seeds in diabetic dogs." Proc Soc Exp Biol Med. 182:159-166, 1986.

24. Sharma RD, Raghuram TC, Rao NS. "Effect of fenugreek seeds on blood glucose and serum lipids in Type I diabetes." Eur J Clin Nutr. 44:301-306, 1990. www.naturesj.com/ejcn

25. Madar Z et al. "Glucose-lowering effect of fenugreek in non-insulin dependent diabetics." Eur J Clin Nutr. 42:51-54, 1988. www.naturesj.com/ejcn

26. Ali L et al. "Characterization of the hypoglycemic effects of Trigonella foenum graecum seed." Planta Med. 61:358-360, 1995.

27. Ribes G et al. "Antidiabetic effects of subfractions from fenugreek seeds in diabetic dogs." Proc Soc Exp Biol Med. 182:159-166, 1986.

28. Haefele C, Bonfils C, Sauvaire Y. "Characterization of a dioxygenase from Trigonella foenum graecum involved in 4-hydroxyisoleucine biosynthesis." Phytochem. 44:563-566, 1997.

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